I always seem to have dandruff – I use good shampoo and conditioner and wash my hair every other day. I dislike wearing black shirts since I feel that I am always “shaking off” the dandruff. Any suggestions?

Thank you,
Donna

Dear Donna,

Thank you for being the first person to take me up on my offer to provide skin care information based on your questions.

Dandruff, also called seborrheic dermatitis, is common and can vary from a mild itch to a severe crusty and scaly rash. Sounds like your problem is mostly scale on your scalp. When I advise people on the care of their scalp dandruff I recommend maintenance care (medicated shampoos) to suppress the problem and interventional care (cortisones and scale removing topical treatments) to control flair ups.

It’s important to know that doctors don’t know what causes dandruff and we can’t cure it. Our goal is to get dandruff into remission and keep it there. It’s easier to maintain a clear and healthy scalp than it is to control a constantly scaling one.That means that you should work really hard to get complete control of the problem by using effective interventional treatments plus shampooing with medicated shampoo every day. Once your scalp is dandruff-free then you can rely on the medicated shampoos for maintenance. Remember that scalp seborrheic dermatitis will flair up from time to time anyway, and you’ll need to go back to the interventional treatments.

In the fall I wrote 2 blog posts with detailed instructions for scalp dandruff. The first outlines my maintenance care with medicated shampoos, the second outlines the interventional care:

I recommend a person get 3 different medicated shampoos, with 3 different ingredientsand rotate them (my favorites in the drug store are Nizoril, DHS Zinc and DHS Sal). The shampoos should be used as I describe in the first post. Ideally the medicated shampoos should be used every day until the dandruff is controlled.

In addition, interventional care needs to be done using treatments that remove the scalp scale quickly. This means using either the mineral oil or the P&S liquid (or alternate both) scalp treatments that I outlined in the second post as often as possible until the scalp scale is gone.

I also recommend using a topical cortisone product like Scalpicin with Hydrocortisone twice a day to the active areas until they clear up. It’s also possible to ask your doctor for a stronger prescription cortisone product.

Do this until the dandruff is gone, at which point the interventional treatments can be stopped.

I recommend continuing to use the medicated shampoos to suppress a recurrence of the dandruff. Shampooing as often as possible will really help to keep dandruff under control.

Remember, if dandruff does not improve within a few months, or if it gets worse with this treatment, then you must see a dermatologist for a diagnosis. There are other conditions that cause dandruff-like scalp scale including common problems like a scalp fungus infection (which will get worse with cortisone application) and psoriasis (which often needs prescription medicines).

Best Wishes and Warm Regards,

Cynthia Bailey MD, Dermatologist

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